Low income nations illustrate better maternal mortality figures: WHO

One year on from a major UN meeting to tackle the deaths of women and babies in childbirth, 44 of the world's poorest countries have made major commitments to the cause, totalling nearly $11bn (£7bn), according to a progress report.

A doctor visits a mother and her newborn baby as part of a home-based neo-natal care scheme which has dramatically reduced infant mortality rates in rural India/ Photo credit: Andy Hall/The Guardian

The UN secretary general, Ban Ki-moon, called the meeting a year ago because of sluggish progress towards two of the UN millennium development goals – reducing maternal and child mortality. More than $40bn was pledged for a range of strategies from donor governments, the private sector, NGOs and philanthropists.

The one-year assessment from the Partnership for Maternal, Newborn and Child Health (PMNCH) of the World Health Organisation highlights progress in the worst-affected countries. Low-income countries made the highest number of commitments overall.

In addition to money, 24 governments committed themselves to expanding access to family planning, 18 to expanding access to skilled birth attendants and 23 to reducing financial barriers to healthcare. Sierra Leone, for instance, has made healthcare free for pregnant woman and small children.

Bangladesh has pledged to double the percentage of births attended by a skilled health worker by 2015 and train 3,000 midwives. Meanwhile, India plans to spend $3.5bn a year on health services, with a special focus on the 264 districts where 70% of infant and maternal deaths occur. "The leadership shown by the lowest-income countries in their commitments to improve women's and children's health has been outstanding," said Dr Julio Frenk, PMNCH chair and dean of the Harvard school of public health.

The UN's global strategy aims to save 16 million lives by 2015. The most recent UN estimates suggest about 358,000 women die in pregnancy or childbirth and 7.6 million children under five, including newborns, die every year.

It is too early to look at what has been achieved, say experts, but there is optimism that the climate has changed and there is a new global focus on preventing deaths in pregnancy and childbirth. About 100 more commitments will be announced on Tuesday at the UN general assembly where a special session will discuss progress.

The report says the major challenge reported in poor countries is getting hold of the money that has been committed. "Stakeholders identified funding shortfalls as the most important constraint to implementation and many also pointed out that there is insufficient clarity on how and when the funds already committed can be accessed," it says. There is also concern that the pledges are almost entirely in the health sector – yet real improvements in the health of women and children also need action in other areas, such as better education, nutrition, water and sanitation.